CAJ | 학술논문

目的探讨神经内镜在显微血管减压术中的应用价值.方法回顾性分析131例应用神经内镜协助显微血管减压术治疗的患者临床资料、手术资料及随访结果.包括101例原发性三叉神经痛患者及30例面肌痉挛患者.手术方式为经枕下乙状窦后入路,并在垫入隔片前后均置入30.神经内镜行多角度的观察,主要目的是观察神经全程及其周围血管,判别责任血管,并观察确认垫片位置,协助垫片调整.116例在内镜下观察,显微镜下行显微血管减压术,15例完全在内镜下手术操作.结果 101例三叉神经痛患者,术后97例(96％)疼痛消失,3例(3％)疼痛减轻,总有效率99％.30例面肌痉挛患者,术后27例(90％)症状完全缓解,2例(6.7％)部分缓解,总有效率96.7％.治疗有效的129例均获随访,随访时间10 -82个月,平均40个月.术后3年内4例有复发,复发率3.1％.15例经神经内镜探查判定责任动脉,22例内镜探查后调整隔片位置.无一例发生颅内感染、出血等并发症.结论应用神经内镜探查能避免遗漏责任血管、协助调整隔片位置,能提高手术有效性,降低术后复发率.
목적 탐토신경내경재현미혈관감압술중적응용개치.방법 회고성분석131례응용신경내경협조현미혈관감압술치료적환자림상자료、수술자료급수방결과.포괄101례원발성삼차신경통환자급30례면기경련환자.수술방식위경침하을상두후입로,병재점입격편전후균치입30.신경내경행다각도적관찰,주요목적시관찰신경전정급기주위혈관,판별책임혈관,병관찰학인점편위치,협조점편조정.116례재내경하관찰,현미경하행현미혈관감압술,15례완전재내경하수술조작.결과 101례삼차신경통환자,술후97례(96％)동통소실,3례(3％)동통감경,총유효솔99％.30례면기경련환자,술후27례(90％)증상완전완해,2례(6.7％)부분완해,총유효솔96.7％.치료유효적129례균획수방,수방시간10 -82개월,평균40개월.술후3년내4례유복발,복발솔3.1％.15례경신경내경탐사판정책임동맥,22례내경탐사후조정격편위치.무일례발생로내감염、출혈등병발증.결론 응용신경내경탐사능피면유루책임혈관、협조조정격편위치,능제고수술유효성,강저술후복발솔.
Objective To explore the value of neuroendoscope in microvascular decompression (MVD) for treatment of idiopathic trigeminal neuralgia(ITN) and hemifacial spasm(HFS).Methods 101 ITN and 30 HFS patients,undergoing neuroendoscope - assisted microvascular decompression was analyzed retrospectively,included their clinical data,operative data and follow - up results.By suboccipital retrosigmoid approach,and applied 30 neuroendoscope to multi -angle exploration before and after placed Teflon.The major effect of endoscope was to visualize the entire nerve and distinguish the responsible vessels and confirm the location of Teflon. 116 cases were performed MVD under the microscope,15 cases were under the endoscope.Results 101 ITN cases,the effective rate was 99％,with 96％ complete cure and 3％little residual pain.In 30 HFS cases,the effective rate was 96.7％,with 90％ complete relief and 3％ little residual spasm.Follow - up was made in 129 successful cases for an average of 40 months.4 cases recurred with in 3 years after operation.15 cases were determine the responsible vessels by endoscope.Correcting Teflon was executed in 22 cases after endoscope exploration.No severe complications including intracranial infection or hemorrhage occurred.Conclusions Endoscope can help avoid missing and distinguish the responsible arteries accurately,assist to rectify the position of Teflon,enhance the effectiveness of MVD,reduce postoperative recurrence rate.